Thursday, July 21, 2016

A study published in the journal Antimicrobial
Agents and Chemotherapy found that nearly 5% of the 400 people
surveyed had used antibiotics without prescription and nearly one-fourth would
intend use antibiotics without a prescription. The study conducted in Texas
showed thatone in twenty used these
antibiotics to treat self-diagnosed viral illnesses like the flu and colds,
even though antibiotics don’t work on viruses and one in four said they would
use any antibiotic they had in the house to treat a sore throat, cough and runny
nose.

The lead author of the study Larissa
Grigoryan said that when people self-diagnose and self-prescribe antibiotics it
is likely that the therapy is unnecessary because most often these are upper
respiratory infections that are mostly caused by viruses. She also pointed out
that the most common conditions patients reported self-treating with
antibiotics were sore throat, runny nose or cough which were conditions that
typically would get better without any antibiotic treatment. The study also
showed that about one in twelve respondents had leftover antibiotics available
at home which could be used, another critical cause for concern.

The study has shown yet gain that
self-prescription of antibiotics was a critical contributor in the process of
antibiotic resistance. Awareness and strict monitoring of purchases would be
crucial to address the problem and should be part of the local, national and
global policies to address antibiotic resistance.

Thursday, July 14, 2016

The multi-drug resistant strain
of E. Coli with the MCR-1 gene has been isolated in New York, in the United
States last week, making it second case the US. In April an isolate with MCR-1
gene was identified in a patient in Pennsylvania who had urinary tract
infection. The new case was identified by the SENTRY Antimicrobial Surveillance
Program, of JMI Laboratories based in the US, that has been analysing samples
from US hospitals and those across the world since 1997. Out of the nearly
20,000 samples tested the lab found almost 2% (390) samples showed the presence
of theMCR-1 gene including from Germany, Italy, Spain, Malaysia, Honk Kong, Brazil
and Russia. These were associated with bloodstream infections, skin infections
and urinary tract infections.

The discovery of the colistin, a
last-line antibiotic, resistant gene in samples from meat as well as hospital
in China last year had led to alarm bells ringing panic across the world on the
extent and spread of the resistance. Moreover most of the cases the gene was
carried on the plasmid DNA of the bacteria which would make it easy for it to
be transferred between bacteria, facilitating its easy and rapid spread which
could become a global public health crisis. After the discovery of the case in
the US, The Centers for Disease Control and Prevention (CDC) and the
Pennsylvania Department of Health are working on trying to trace the origin of
the bacteria to prevent any possible spread as well as understand its
environment to ascertain if there could be more cases.

This, is another call for the
adoption and implementation of stricter and more rational antibiotic use across
the world in order to avoid more chances of the development of such multi-drug
resistant "superbugs".

Saturday, June 18, 2016

Research paper from the University of Miami have indicated that having shorter course of antibiotic treatment is as effective as long courses in reducing post-surgical infections . The paper based on randomized controlled trial of patients with complicated intra-abdominal infection (CIAI) found that four days of antibiotic therapy worked as well as the seven currently recommended in medical practice.

Published in the New England Journal of Medicine, the research said there was no difference between those in the short-course and those in the long-course arm in incidence of surgical site infection, recurrent intra-abdominal infection, CDI [Clostridium difficile infection] or any other extra-abdominal infection . It also says that the findings hold true even for those at higher risk for infection making it an important consideration in an era investigating ways to curtail overuse of antibiotics at hospitals.

The findings though are of single study and is more of a hypothesis-generating nature, it still underscores the fact that antibiotic stewardship is an important part of a broad strategy to reduce the risk of antimicrobial resistance. The findings of the study contributes to the growing body of literature on infection risk factors and antibiotic resistance.

Friday, May 20, 2016

A meta-analysis study published
by Brown University, US researchers have indicated that if a hospital adopts an
antibiotic stewardship program its infection levels would drop considerably.
The study published in the journal of the American Society for Microbiology
last week, showed that such programs reduce use of antibiotics by more 20% in
overall with maximum reduction in the Intensive Care Units (ICUs) of nearly 40%
which is a key site for infections.

Use of restricted antibiotics
fell by more than one-fourth after an a stewardship program, and use of
broad-spectrum antibiotics declined by nearly one-fifth the study showed. The
study also quelled fears that restricted use of one drug would increase dramatically
the consumption of others. The study showed overall infections were reduced by
5% across hospitals that have started antibiotic stewardship programs and reduced
length of hospital stay by around 9%. The expenditures incurred to hospitals in
buying antibiotics also fell sharply.

The study reaffirms the fact that
adopting an antibiotic stewardship program has multi-faceted benefits to the
hospital: drug expenditures, infection rates, and length of hospitalization and
most importantly use of antibiotics. This should serve a tool to dispel popular
myths that following antibiotic stewardship program would affect the hospital's
service quality and patient outcomes as well as finances. It should be part of
health policy to enforce such stewardship programs in all health facilities to tackle
the issue of antibiotic resistance.

Thursday, April 28, 2016

Microbiologists from six
major hospitals of the country are scheduled to meet in New Delhi and finalise
the draft of the standard operating procedures (SOPs) to be used by hospitals
to address antibiotic resistance. These six facilities PGI in Chandigarh, JIPMER in Pondicherry,
AIIMS in Delhi, CMC in Vellore, PD Hinduja in Mumbai, and Assam Medical College
in Dibrugarh would develop the draft which would then be implemented in other
health-facilities in the country.

The SOP will include antibiotic
stewardship, methodology regarding defining a case or recording a case will, an
infection control manual and steps to calculate infection rates. It would
outline a systematic defining and managing infection rates through a central software, pool
the data making a national registry. The project is executed by AIIMS, Centres
for Disease Control (USA) and Indian Council for Medical Research (ICMR). ICMR has
already made four of the facilities: PGI in Chandigarh, JIPMER in Pondicherry,
AIIMS in Delhi, CMC in Vellore as nodal centres for tracking drug resistances a
few years back.

This is a great step forward in
India as the country yet to have a set of SOPs for health-facilities that are
contextual and implementable. The involvement of public and health private hospitals
in developing the guidelines would increase its acceptability in India's fragmented
healthcare system.

Thursday, April 21, 2016

Last week at the IMF meeting in
Washington, UK Chancellor George Osborne stated that 10 million people a year
could die across the world by 2050. This was more than the number of people dying
due to cancer each year. The Chancellor also warned of the economic cost of resistance
which could cut global GDP by 3.5%, a cumulative cost of $100bn (£70bn). Thus,
unless global action is taken, antimicrobial resistance will become an even
greater threat than cancer currently is.

The panel which is part of the
IMF's Annual Spring Meeting is being held in Washington DC and is looking at
emerging economic concerns that could arise in the future. WHO representatives
would also be attending the meeting to put forward health concerns that could
result in economic challenges.

While there is recognition of the
health impact of antibiotic resistance, the human costs and economic costs are
seldom discussed. Given that pharmaceutical companies, drug manufacturers and
the markets play a critical role in shaping healthcare outcomes and policies
for antibiotic use, it is critical that bodies like the IMF are aware and act
on health concerns due to antibiotic resistance. Without policies and
incentives to regulate the drug market, the battle against antibiotic resistance
would certainly be impossible to win.

Thursday, March 31, 2016

Over 2 million fewer antibiotic
prescriptions were dispensed in primary care throughout 2015 compared to the
year before, according to data from NHS (National Health Service) in the UK. This
was 7.9% reduction was attributed the incentives introduced to general
physicians as well as extensive campaigns to build awareness on antibiotic resistance.

The NHS along with the Public
Health England Department had initiated these campaigns with emphasis in
hospitals on vaccinations, general hygiene practices and judicious prescribing
of antibiotics. Healthcare facilities and healthcare providers following these recommendations and
demonstrating fall in antibiotic prescribing and consumption were given
financial incentives through the campaigns. Given that safely reducing the
amount of antibiotics prescribed to patients was an important part of work to
tackle antimicrobial resistance, the NHS
and the PHE had started series of campaigns to reduce prescription of
antibiotics. It was based on the fact that inappropriate use
and overuse of antibiotics were known drivers of resistance, so reducing the
amount of antibiotics consumed slowed bacteria developing resistance to these
vital drugs and therefore helped prevent antibiotic-resistant infections.

The NHS officials have lauded these results and promised to do more to tackle the menace of antibiotic
resistance. This a good impetus for other countries to follow, by taking up initiatives
involving the healthcare system itself to achieve substantial results in curbing
antibiotic resistance.